Psychopathology

What are the 4 definitions of abnormality?

1. Deviation from social norms

2. Failure to function adequately

3. Statistical infrequency

4. Deviation from ideal mental health

Explain ‘deviation from social norms’

Behaviour is ‘abnormal’ if it violates (unwritten) societal rules about what is expected/acceptable in a particular social group.

Evaluation of ‘deviation from social norms’

Strength:

• Social norms are useful for assessing behaviour and ensuring that societies can run smoothly

Weaknesses:

• Defining abnormality may lack temporal validity -

  • Norms and conceptions of abnormality change over time

• Defining abnormality is culturally relative

  • Applying definitions of norms across cultures may be ethnocentric

  • If they are not generalised, they can help appreciate cultural differences (e.g. culture-bound syndromes like anorexia)

Explain ‘failure to function adequately’

Behaviour is ‘abnormal’ if they are unable to cope with life’s demands. (e.g. hold down a job, interact with others etc.)

Rosenhan & Seligman’s criteria for inadequate functioning

1. Suffering

2. Maladaptiveness (dangerous to self)

3. Vivid & unconventional (stand out)

4. Unpredictable & not controlled

5. Irrationality/Incomprehensible

6. Causes others discomfort

7. Violates moral/social standards

(Some Monkeys Venture Under Ice Cream Vans)

Evaluation of ‘failure to function adequately’

Strength:

• Takes patient’s perspective into account

Weaknesses:

• Culturally biased as functioning is defined largely by social norms (e.g women in other cultures go long periods w/o eating - explains why non-white patients are diagnosed with abnormality more often)

• Many people fail to function normally sometimes but are not considered abnormal (e.g. post trauma)

• Many people engage in behaviour that is maladaptive but are not considered abnormal (e.g. smoking, drinking)

Explain ‘deviation from ideal mental health’

With this definition, we define what is normal and anything that deviates from it is considered abnormal.

Jahoda's 6 criteria for ideal mental health

1. Positive view of the self

2. Capability for growth and development

3. Autonomy and independence

4. Accurate perception of reality

5. Positive friendships and relationships

6. Environmental mastery

(Penguins Can Always Avoid Predators Easily)

Evaluation of ‘deviation from ideal mental health’

Strength:

• The criteria provides useful targets for goal-setting (e.g. in CBT)

Weaknesses:

• Defining normality is culturally relative

  • Applying definitions of norms across cultures may be

  • If they are not generalised, they can help appreciate cultural differences (e.g. culture-bound syndromes)

• Jahoda set the bar too high

  • Strictly applied, few people meet the criteria, therefore everybody is abnormal and the concept becomes meaningless

Explain ‘statistical infrequency’

This definition deems a behaviour as abnormal if it is extremely rare using the mean, median or mode of recorded data.

On a graph the most ‘abnormal’ people will make up the tail ends of the curve

Evaluation of ‘statistical infrequency’

Strength:

• This is objective and logical and can be done without bias

  • (Weakness) However, the cut-off point used to determine ‘abnormality’ is still subjective

• SI can also be combined with other definitions

  • e.g. low IQ can be diagnosed successfully when it occurs in addition with features of other definitons

Weakness:

• Statistically rare behaviours/traits can be desirable (like IQ)

What do psychologists use to diagnose mental disorders?

• DSM

• ICD (used in UK)

These include a list of symptoms, which can be used as a tool for diagnosis.

What are the types of phobias?

• Specific phobias (e.g. animals, heights, situations)

• Social phobias - concerns about our own behaviour and others’ reactions

• Agoraphobia - person perceives their environment to be unsafe with no easy way to escape.

Behavioural characteristics of phobics

• avoiding social situations because they cause anxiety

  • agoraphobia and social phobias especially

• restlessness and altered behaviour (e.g. to escape)

Cognitive characteristics of phobics

• irrational thoughts - involve catastrophising

• selective attention to feared object

• they recognise their fear is excessive

  • distinguishes phobias from delusional mental illnesses

Emotional characteristics of phobics

• persistent fear

• anxiety and panic

Behavioural explanations to phobias

• The two-process theory looks at the acquisition and maintenance of a phobia.

  • It theorises that phobias are acquired by classical conditioning and maintained by operant conditioning.

  • When confronted by the feared object/situation, phobis will retreat from the situation. This relieves them from their anxiety and acts as a form of negative reinforcement.

• Phobias may also be acquired via modelling others’ behaviour (SLT).

SLT study for explaining phobia acquisition

Mineka et al. :

• Monkeys in separate enclosures, but visible to each other

• One monkey is bitten by a snake and the second monkey witnesses its fear response

• The second monkey now reacts with anxiety, when shown a snake

Evaluation of the behavioural explanation of phobias

Strengths:

• Backed with research support

  • e.g. Mineka & Watson and Rayner’s studies

Weaknesses:

• The two-process theory is reductionist as it ignores cognitive factors

  • the impact of irrational thoughts is major in phobics

• It is also deterministic

  • obviously, not everyone will develop a fear of dogs if they are bitten

  • The diathesis-stress model describes that certain people are more predisposed to develop fears (e.g. due to genes). This is known as ‘preparedness’.

Behavioural methods to treating phobias

• Systematic desensitisation

  • in vivo desensitisation (direct confrontation)

  • covert desensitisation (imagining scenarios)

• Flooding

  • in vivo

  • virtual reality

Steps of SD

1. Relaxation techniques taught

   • This is counter-conditioning (associate feared stimulus with relaxation instead of fear)

2. Construct desensitisation hierarchy

3. Visualise each scenario and practice relaxing. Move onto the next scenario after mastering each step

4. Patient eventually masters their fear

How does flooding work?

Flooding still involves the learning of relaxation techniques, but the client is immersed in the feared experience in one long session until their anxiety disappears.

The adrenal response has a time limit. The aim is to create a new stimulus-response link as adrenaline levels decrease.

Evaluation of behavioural therapies for phobias

Strengths:

• Research support for SD

  • Gilroy’s study on the effectiveness of SD found that after both 3 and 33 months an SD group were less fearful of spiders on a questionnaire than controls

• Appropriate for a wide range of patients

  • They don’t require active reflection in the therapy. For some patients (e.g. with special needs), this may be easier than complex therapies like CBT

Weakness:

• Flooding may raise ethical issues

  • The treatment can be traumatic and cause psychological harm

  • This can lead to high refusal rates (incompletion of the therapy), which is a waste of time + money.

Types of depression

• Major Depressive Disorder

  • prolonged presence of depressed mood

• Bipolar Disorder

  • refers to two extremes of mood - mania and depression

Behavioural characteristics of people with depression

• Reduced/increased activity activity level

  • things like socialising and sex drive

• Sleep disturbances

  • Insomnia - inability to sleep

  • Hypersomnia - sleeping more than usual

• Self-harm

Cognitive characteristics of people with depression

• Persistent negative beliefs about themselves

• Slower thought processes (difficulties concentrating)

• Suicidal thoughts

Emotional characteristics of people with depression

• Anhedonia - sadness and loss of pleasure

• Feelings of emptiness + hopelessness

• Feelings of anger

  • Can be towards the self or others

Cognitive explanations of depression

• Beck’s negative triad

  • Depressed people may have acquired a negative self-schema (maybe from early criticism in childhood). These lead to cognitive biases about self-worth

  • This causes the maintenance of the negative triad, which consists of negative views of the world, future and self

• Ellis’ ABC model

  • Ellis proposed that the key to depression is irrational beliefs

  • A = Activating Event

    B = Belief (irrational)

    C = Consequence (unheallthy emotions)

  • Ellis proposed that depressed people tend to think in absolutes aka. ‘mustabatory thinking’. They assume that certain things must be true for their happiness.

Beck et al study

50 patients with depression and 31 non-depressed patients underwent therapy. They were matched for age, sex and social status.

The thoughts of the patients were recorded before and after the session.

Themes of low self-esteem, self-blame and anxiety appeared in the depressed patients. They also regarded themselves as inferior to others in their social groups.

Evaluation of Beck’s study

Strengths:

• matched pairs design - good for comparing depressed to non-depressed

• practical application - Beck’s theory helped develop CBT

Limitations:

• low temporal validity - it was conducted in 1974

• doesn’t help explain complex symptoms of depression - such as hallucinations and delusions

The 3 most important irrational beliefs for depression (according to Ellis)

1. “I must be liked by people I find important”

2. “I must do well, or I am worthless”

3. “The world must make me happy, or I will die”

Evaluation of Ellis’ Model

Strength:

• useful applications - it becomes the ABCDEF model for treatment.

  • D = Disputing irrational beliefs

  • E = Effective attitude

  • F = Feelings produced

Weaknesses:

• explanation is reductionist - ignores biological factors

• only accounts for reactive depression - depression that arises from an obvious cause

How does REBT work?

REBT stands for rational emotive behaviour therapy. It uses Ellis ABC model and adds D, E and F

A = Activating Event that causes feelings of depression

B = Irrational Belief based on that event

C = Self-defeating Consequence because of beliefs

D = Dispute the irrational beliefs

E = Create a more positive Effective attitude

F = Feelings produced

Ellis proposed that disputing an irrational belief can help turn it into a more rational one and prevent catastrophising

Types of disputing

• Logical disputing - irrational beliefs are not logical

• Empirical disputing - irrational beliefs are not consistent with reality

• Pragmatic disputing - irrational beliefs are useless

Features of REBT

• Homework - clients are given assignments (e.g. asking someone out on a date) to help test irrational beliefs

• Behavioural activation - encourages activeness and engagement in pleasurable activities

• Unconditional positive regard

Evaluation of CBT for treating depression

Strengths:

• research support - Kuyken et al conducted a meta-analysis and found that CBT is effective in curing depression and has population validity

• deals with the root cause, not symptoms

Weaknesses:

• not appropriate for all patients

  • Elkin found that it was unsuitable for people who are resistant to change

• expensive + time consuming

  • may not always be offered e.g. health services on limited budgets

Background on OCD

• classified as an anxiety disorder

• typically develops in childhood

• two components

  • obsessions - persistent thoughts

  • compulsions - persistent behaviours

Cognitive characteristics of OCD

• obsessions - recurring thoughts

  • may refuse to share them as they could be dangerous/embarrassing

• they recognise that the impulses are a product of their own mind

Behavioural characteristics of OCD

• compulsions are performed to reduce anxiety caused by obsessions

• sufferers feel as if they must perform these actions (e.g. hand washing, checking)

Emotional characteristics of OCD

• anxiety and stress

• their excessive behaviour causes them to feel embarrassment and shame

2 ways of biologically explaining OCD

• genetics

• neural factors

How do genetics explain OCD

OCD is polygenic (caused by many genes)

• COMT gene

  • regulates breakdown of dopamine in synapse

  • low COMT → high dopamine

  • high dopamine has been linked to OCD by Tukel et al.

• SERT gene

  • controls the transport of serotonin

  • low serotonin has been implicated in OCD

How do neural factors explain OCD

• obsessions may occur through overactivity in a ‘worry circuit’ involving the orbitofrontal cortex (OFC), which is used to assign value to things

• compulsions may be caused by a hyperactive basal ganglia, which is used to select intended actions

Evaluation for biological approach to explaining OCD

Strengths:

• research support for role of genetics from Billet et al.

  • meta analysis that found that MZ twins twice as likely to suffer from OCD if their twin had OCD

  • however concordance rate was not 100% so other factors must contribute to OCD development

• research support for neural factors from Evans et al. who found that OCD patients had hyperactive OFCs compared to controls

  • The magnitude of hyperactivity correlated to severity

Weaknesses:

• reductionist - doesn’t take cognition into account

• a diathesis-stress explanation may be more suitable

  • For example, children with a family history of OCD may be more vulnerable to developing OCD

Biological approach to treating OCD

• SSRIs

  • work by preventing the reuptake of serotonin by the presynaptic neuron and increasing concentration at post-synaptic

  • low serotonin is linked to OCD development

• Tricyclics

  • prescribed if SSRIs ineffective

  • inhibit both serotonin and noradrenaline reuptake

• BZs

  • these combat the anxiety caused by OCD. they slow neuron activity, making the person feel relaxed

Evaluation of biological treatments for OCD

Strengths:

• Zohar et al. found that SSRIs helped 60% of patients with their symptoms

Weaknesses:

• drugs only treat symptoms, not the cause

  • patients often relapse within a few weeks and they may become trapped into taking drugs long term

• the treatment is both reductionist and deterministic

  • Zohar et al shows that the treatment doesn’t always work suggesting that there are more factors in OCD development

  • interactionist treatments use multiple treatments, such as CBT and SSRIs at the same time. This is found to be more effective